Standing Committee A

[Miss Ann Widdecombe in the Chair]

NHS Reform and Health Care Professions Bill

Ann Widdecombe: Following Mr. Hurst's ruling this morning, the Government have tabled manuscript amendments. They will be taken during the debate on clause 36 and they are available to the Committee on the Table.

Simon Burns: On a point of order, Miss Widdecombe. As you were not in the Committee this morning, you may not be aware that we held a further meeting of the Programming Sub-Committee when we had before us the motion
 ''That, pursuant to Sessional Order . . . of 28th June 2001, the Committee recommends that, notwithstanding the Order of the House of 20th November, proceedings on Consideration and Third Reading of the National Health Service Reform and Health Care Professions Bill be completed in one and a half days.'' 
My hon. Friend the Member for North-East Hertfordshire (Mr. Heald) and I requested that because we felt that the way in which the programme motion for the Committee had been set provided insufficient time to debate important issues such as clauses 8, 20 and 21. We did not have the opportunity to scrutinise those clauses at all, which it is the Opposition's duty so to do, and we thought it reasonable to request that on Report, instead of having the proposed one-day debate, we should have a one-and-a-half day debate so that we could properly scrutinise those important clauses. Regrettably, the Programming Sub-Committee, with a Government majority, did not agree with that view, so the status quo remains. However, I want to put on the record that we are most unhappy at the way in which those crucial clauses at the heart of the Bill will not have any scrutiny whatever in Standing Committee.

Ann Widdecombe: That is not a matter for the Chair. The Programming Sub-Committee met and came to a conclusion in a way that was completely within the rules. I certainly have no jurisdiction to do anything about it. If the hon. Gentleman is dissatisfied, no doubt he will make that known on the Floor of the House in due course.Schedule 8 Minor and consequential amendments

Schedule 8 - Minor and consequential amendments

John Hutton: I beg to move amendment No. 114, in page 79, line 27, at end insert—
 'In section 18 (duty of quality), in subsection (1), at the beginning there is inserted ''It is the duty of each Strategic Health Authority to put and keep in place arrangements for the purpose of monitoring and improving the quality of health care which is provided to individuals in their area, and''.'

Ann Widdecombe: With this it will be convenient to take Government amendment No. 258.

John Hutton: Amendment No. 114 amends section 18 of the Health Act 1999 and amendment No. 258 amends section 11 of the Health and Social Care Act 2001.
 Section 18 of the 2001 Act currently places health authorities under a duty to put and keep in place arrangements for the purpose of monitoring and improving the quality of health care which they provide to individuals. The amendment amends that duty in relation to strategic health authorities so that each authority will in future be under a duty to put and keep in place arrangements for monitoring and improving the quality of health care provided to individuals in their area, instead of, as at present, the health care which the authority provides to individuals. That duty will better reflect the primary role of strategic health authorities as strategic bodies rather than as providers of services. 
 In a nutshell, I hope that the Committee will find amendment No. 114 straightforward. Its purpose is to ensure that the duty of quality contained in the 1999 Act applies to strategic health authorities in a way that reflects their new responsibilities. 
 Amendment No. 258 amends section 11 of the Health and Social Care Act 2001. That section currently confers on each health authority, primary care trust and NHS trust a duty to make arrangements with the aim of involving patients and the public in the planning and decision-making processes of those bodies, in so far as they affect the operation of the health services for which that body is responsible. In relation to health authorities, that would cover both the hospital and community health services for which they are responsible and the family health services provided by practitioners in those areas. The amendment imposes on strategic health authorities all the consultation-related duties of section 11, in so far as the strategic health authorities are themselves responsible for health services, and gives the authorities a new power to direct both PCTs and NHS trusts on how they should carry out consultations on services for which they have responsibility. The amendment adds strategic health authorities to the list of bodies to which section 11 applies. 
 New subsection (5) provides the new direction-making power for strategic health authorities, the scope of which is defined in new subsection (4). New subsection (6) makes it the duty of PCTs and NHS trusts to comply with directions given by the strategic health authority. 
 The amendment imposes on strategic health authorities all the consultation-related duties of section 11 of the 2001 Act in case the authorities might be responsible for health services and gives them a new power to direct PCTs as well as NHS trusts on how they should carry out consultation on services.
 It might be helpful if I explain a little more of the detail of amendment No. 258 because I understand that the Opposition are concerned about it. With resources and commissioning being handled in future by PCTs directly, strategic health authorities will not be responsible for such services in quite the same way, but they will be responsible for their overall performance management. It is our intention that strategic health authorities should be under a duty under section 11 in two respects. My explanation may be helpful to the hon. Member for West Chelmsford (Mr. Burns). 
 The first duty is broadly to oversee consultations carried out by PCTs and NHS trusts. That may, for example, include being able to require PCTs and trusts in their area to co-ordinate consultation on health service issues affecting the whole strategic health authority area. That is sensible. Secondly, and more generally, situations may arise in which the Secretary of State may wish to delegate certain strategic service functions to strategic health authorities. An example that arose previously was the public health function. In those circumstances, we would want strategic health authorities to be under a proper duty to consult local people. 
 That is what the amendments are designed to do. They do not change policy, but tidy up the Bill to ensure that those two provisions in earlier Acts properly reflect the new responsibilities of strategic health authorities. They will, as I hope the Committee now appreciates, take a step back from direct service provision, which is their current overall responsibility, to a more strategic approach.

Simon Burns: I thank the Minister for his explanation of the amendments, particularly amendment No. 258. As he rightly said, my hon. Friend the Member for North-East Hertfordshire particularly wanted the Minister to explain the amendment.
 So that there is no misunderstanding on the Opposition Benches, I want to paraphrase my understanding of what the Minister said to ensure that I am clear about the purpose of the amendment. Is it fair to say that the amendment will ensure that strategic health authorities are in the same position as health authorities at the moment, so that when they are created they will have the same sort of role as health authorities in this area?

John Hutton: That is broadly right, but, of course, the role of the strategic health authorities is fundamentally different from that of the health authorities at present. The amendments tidy up the provisions to ensure that the duties of consultation and quality from earlier legislation apply appropriately to strategic health authorities with their new responsibilities.
 It may be helpful if I confirm that the duty of consultation in section 11 of the Health and Social Care Act 2001 is a general duty to maximise public involvement in decision-making within the NHS. That is not the same as the specific statutory duty to consult on service reconfigurations in the National Health 
 Service Act 1977. Section 11 of the 2001 Act laid some of the foundations for the wider reforms that we wanted in relation to public and patient involvement in the NHS. I accept that those are controversial issues, but the duty in section 11 of the 2001 Act is in addition to the statutory duty of consultation on service reconfigurations, so the responsibility for consultation in relation to service changes is not affected by the amendments. They simply re-align the two existing statutory duties of quality and consultation with the new responsibilities of the strategic health authorities. The amendments do not constitute a substantive change of policy or a withdrawal from the duty of quality or of consultation. 
 Amendment agreed to. 
 Amendments made: No. 133 in page 79, line 27, at end insert— 
 'In section 21 (arrangements with the Audit Commission), in subsection (1)(a), for ''20(1)(b) or (d)'' there is substituted ''20(1)(b), (d), (da) or (db)''.'
 No. 258, in page 79, line 34, at end insert— 
 'In section 11 (public involvement and consultation)— 
 (a) in subsection (2), before paragraph (a) there is inserted— 
 ''(za) Strategic Health Authorities,'', and
(b) after subsection (3) there is inserted— 
 ''(4) Subsection (5) applies to health services for which a Strategic Health Authority is not responsible by virtue of subsection (3), but which are provided or to be provided to individuals in the area of the Authority, and for which— 
 (a) a Primary Care Trust whose area falls within the Authority's area, or
(b) an NHS trust which provides services at or from a hospital or other establishment or facility which falls within the Authority's area, is responsible by virtue of subsection (3). 
 (5) A Strategic Health Authority may give directions to Primary Care Trusts falling within paragraph (a) of subsection (4), and NHS trusts falling within paragraph (b) of that subsection, as to the arrangements which they are to make under subsection (1) in relation to health services to which this subsection applies. 
 (6) It is the duty of each Primary Care Trust and each NHS trust to which such directions are given to comply with them.'' '.—[Mr. Hutton.]
 Schedule 8, as amended, agreed to.

Schedule 9 - Repeals

John Hutton: I beg to move amendment No. 259, in page 81, line 5, at end insert—
'Health Services and Public Health Act1968.In section 63(5B), the ''and'' at the end of paragraph (bb).'.

Ann Widdecombe: With this it will be convenient to take Government amendments Nos. 260 to 264.

John Hutton: This is another fiendishly descriptive part of the Bill. The amendments add to the table in schedule 9, which in turn lists all the repeals provided for in other clauses and schedules to the Bill. The Acts referred to are, I hope, self-evident, but I draw the Committee's attention to amendment No. 264, which
 in a curious and somewhat inexplicable way—I shall try to explain in a moment—repeals provisions in the current Bill. I suspect that that must be a first.
 Reference is made to amendments to section 15 of the National Health Service Act 1977 that are added to paragraph 2 of schedule 2 by amendment No. 99, which the Committee has already approved. We have already amended the Bill in Committee, which is what the amendments to schedule 9 try to reflect. Reference is also made to amendments to section 18 of the National Health Service and Community Care Act 1990 through amendment No. 100. Both the relevant amendments provide for their own repeal. They are amendment provisions that are themselves repealed by provisions in the Health Act 1999 that have yet to come into force. 
 I realise that a fog is probably descending on the Committee, but I shall carry on. I should warn the hon. Member for West Chelmsford that if he asks me any questions about this matter, I shall definitely have to correspond with him. 
 The amendments provide for their own repeal, as well as for the repeal of the substantive provisions that they amend. In summary, the amendments are further repeals that take account of the provisions in the Bill. In essence, they are tidying-up provisions. Schedule 9 lists in tabular form all the repeals included in other clauses and schedules to the Bill, and amendments Nos. 259 to 264 simply add to that table. They are all consequential repeals, which are necessary in the light of amendments to the Bill that we accepted in Committee. I do not propose to detain the Committee by discussing them individually. As I said, the Acts referred to are, I hope, self-evident.

Simon Burns: I thank the Minister for that somewhat unusual explanation of his amendments. He is probably right in saying that this may be a first, in that amendment No. 264 amends the Bill before it has even reached the statute book, but why do we need to do that? Why could we not table the relevant amendment to schedule 2 on Report or in another place, thereby avoiding this unusual procedure?

John Hutton: Those are options. The amendments could indeed be tabled on Report, in another place or anywhere else.

Simon Burns: I was talking about just this one.

John Hutton: This one could be tabled anywhere. It is a perfectly legitimate amendment, and the Government are entitled to make such changes at any point in the Bill's legislative passage. However, we wanted to do so in Committee because this is the time and place that such amendments are usually tabled. As I understand it, they are simply consequential, tidying-up amendments that are necessary because of changes already made to the Bill through amendments Nos. 99 and 100 in particular. They go no deeper than that. Making such changes in Committee, on Report or in
 another place is a question of judgment for Ministers. I felt that it would be helpful to consider them in Committee.

Amendment agreed to. 
 Amendments made: No. 260, in page 81, line 8, column 2, at end insert—  'In section 22(1A), the ''or'' at the end of paragraph (c).  In section 28A(1), the ''and'' at the end of paragraph (a).'. No. 261, in page 81, line 13, column 2, at end insert— 'In section 51(3), the ''and'' at the end of paragraph (bb).'. No. 262, in page 81, line 15, column 2, at end insert—  'In section 125, the ''and'' at the end of paragraph (bb).'. No. 263, in page 81, line 23, at end insert— 'Acquisition of Land Act 1981.In section 16(3), the ''and'' at the end of paragraph (b). Health Service Commissioners Act 1993.In section 2, in subsection (1)(da), ''established for areas in England''; and in subsection (2)(a), ''whose areas are in Wales''.  Government of Wales Act 1998.In Schedule 5, in paragraph 20, ''for an area in, or consisting of, Wales''.In Schedule 17, in paragraph 12, ''for an area in, or consisting of, Wales''.'. No. 264, in page 81, line 35, at end insert—  'National Health Service Reform and Health Care Professions Act 2002 (c. )In Schedule 2, in paragraph 2, sub-paragraphs (3) to (5); and paragraph 55.'.—[Mr. Hutton.]

Schedule 9, as amended, agreed to.Clause 36Regulations and orders

Clause 36 - Regulations and orders

John Hutton: I beg to move manuscript amendment (a), in page 41, line 22, after 'than' insert
'regulations under section 26 or'.

Ann Widdecombe: With this it will be convenient to take manuscript amendment (b).

John Hutton: It will be obvious to all members of the Committee that the manuscript amendments are a response to this morning's debate on clause 26, in which I made it clear that I was minded to accept the calls of the hon. Member for West Chelmsford and my hon. Friend the Member for Crawley (Laura Moffatt) for regulations made under clause 26 to be approved by affirmative resolution of both Houses and not, as we originally proposed, by the negative resolution procedure.
 The amendments do indeed provide that regulations made under clause 26 will be subject to affirmative resolution procedures. They are a response to the Opposition's argument, with which I agree, that 
 regulations made under clause 26 are unusual and merit greater parliamentary scrutiny than the negative resolution procedure would provide. 
 As I said during our discussion of clause 26, I am persuaded by the argument for a higher level of parliamentary scrutiny of the arrangements dealt with in the clause. Systems such as these are not normally set up through secondary legislation, but dealt with by the parliamentary ombudsman and included in primary legislation. In the light of the way in which the amendments provide for regulations to be made, I hope that they will command the support of the Opposition. 
 Because clause 36 provides for the making of orders and regulations under the Bill, the amendments—unlike those tabled by the hon. Member for West Chelmsford—amend clause 36 and not clause 26, even though they refer to regulations dealt with in clause 26. Manuscript amendment (a) amends clause 36(2), which provides for regulations in the Bill to be subject to the negative resolution procedure, by excluding regulations under clause 26 from the negative resolution procedure. Manuscript amendment (b) amends clause 36(3), which lists the secondary legislation that is subject to the affirmative procedure, by adding the regulations under clause 26 to the list that requires the affirmative procedure.

Simon Burns: I thank the Minister for his explanation of the manuscript amendments and for the swift way in which he, the parliamentary draftsmen and, one assumes, other civil servants in the Department of Health have worked since our discussions some time after 9.30 this morning to produce the amendments in time to amend the Bill in Committee.
 Because you were not chairing the Committee this morning, Miss Widdecombe, you may not be aware that the amendments that gave rise to the principle behind the manuscript amendments were tabled in my name and that of my hon. Friend the Member for North-East Hertfordshire. Given the importance of the issue, we believe that the regulations should be made under the affirmative resolution procedure, and according to the Minister, the hon. Member for Crawley—I note that she is not in her place—shares our concern. We have all been in government from time to time, so we understand the way in which these matters work. We welcome any conversions from the other side, so we welcome the support given by the hon. Member for Crawley for a change from the negative to the affirmative resolution procedure. Given her great concerns about the matter, I would have been more than happy had she felt able to add her name to our amendments. That was not to be, but at least she is with us in spirit in our argument. 
 May I also say what a pleasure it is that the Government accepted the amendment? If one is in opposition when the Government have such a large majority, any crumbs from the table are welcome. Gratefully, although not with much pride, I accept the crumb that the Minister has thrown us today. We are 
 delighted that he agrees with us and sees the merits and worth of our argument, and that he and his draftsmen have come up with the amendments so swiftly. 
 In conclusion, I can only thank the Minister for his swift and gracious actions and assure him that we will support the son of our original amendment 100 per cent.

John Hutton: Can I simply place on the record my appreciation of the hon. Gentleman's words about my officials? I am sure that they will be greatly appreciated in the Department of Health.
 Manuscript amendment agreed to. 
 Manuscript amendment made: (b), in line 25, after ''containing'' insert 
''regulations under section 26 or''.—[Mr. Hutton.]

John Hutton: I beg to move amendment No. 94, in page 42, line 7, at end insert—
 ''( ) Directions given in pursuance of any provision of this Act are, except where otherwise stated, to be given by instrument in writing.
 ( ) Any power conferred by this Act to give directions by instrument in writing includes power to vary or revoke them by subsequent directions.''.
 The amendment provides that any directions made under the Act are, unless otherwise stated, to be given by instrument in writing and that any directions may be varied or revoked by subsequent directions. The powers affected are threefold: the power of the National Assembly for Wales relating to health and well-being strategies in clause 22(7); powers in relation the Commission for Patient and Public Involvement in Health in paragraphs 2(1) and 10(4) of schedule 6; and powers concerning payments and loans to the Council for the Regulation of Health Care Professionals in paragraphs 13, 7 and 8 of schedule 7. 
 The intention is that all directions under the Act should, unless otherwise stated, be able to be issued in writing without the need for any parliamentary procedure. That is the procedure used in most cases for directions under the National Health Service Act 1977. 
 Amendment agreed to. 
 Clause 36, as amended, ordered to stand part of the Bill.

Clause 37 - Supplementary and consequential provision etc

John Hutton: I beg to move amendment No. 257, in page 42, line 15, at end insert—
''including an enactment contained in an Act passed in the same session as this Act''.
 The amendment extends clause 37 so that supplementary and consequential provisions may be made by order in relation to Bills passed in the same Session as this one. For example, other Bills passed in this Session that refer to health authorities, will be able to be updated to refer to strategic health authorities by order without us having to wait for another opportunity to make primary legislation.
 Various other Bills are in progress in this Session, such as the Adoption and Children Bill, the International Development Bill and the police Bill, which currently contain references to health authorities. Those will need to be amended after enactment to read ''strategic health authorities''. We had originally thought that that could be done by an order under clause 37 of this Bill, but the normal rule of interpretation would confine the section 37 power to enactments passed prior to this Act. It would therefore be correct to extend clause 37 to include explicitly Bills enacted in the same Session as this one.

Simon Burns: The Minister has given a lucid explanation of the reason behind the amendment. If I understand him correctly it is, to all intents and purposes, a technical amendment to allow changes to other legislation. He mentioned the Adoption Bill, International Development Bill and the police Bill. Does the Minister anticipate, during the current Session of Parliament, a further health Bill from his Department that would also have this amendment applied to it?

John Hutton: No.
 Amendment agreed to. 
 Clause 37, as amended, ordered to stand part of the Bill. 
 Clauses 38 and 39 ordered to stand part of the Bill.

Clause 40 - Short title, interpretation,commencement and extent

Question proposed, That the clause stand part of the Bill.

Simon Burns: I will be brief, but as we are nearing the end of the Bill, it would be remiss of me not to end, or almost end, on the point on which I began. The clause deals with, among other things, the commencement of the Act, if and when it becomes one. That brings us back to the argument of whether the Government are rushing the introduction of PCTs and strategic health authorities too quickly.
 I will not test your patience, Miss Widdecombe, by rehearsing yet again the arguments that Opposition Members made vigorously in the early stages of the Committee. However, I want to put it on record, if only to protect myself in a year or 18 months' time when there is an utter shambles, that we the Opposition flag up that we are as concerned as we were at the start of the Committee that the Government's reforms, on PCTs in particular, are being rushed. We still believe that it would have been wise and sensible to have postponed enabling PCTs to act as they will under the legislation for six months, until April 2003. 
 I will leave it there, having simply put it on the record that we have warned the Government and shown them what we believe is the folly of their undue rush. If, sadly, our fears become reality, the Government must realise—unusually for this 
 Government—that they have only themselves to blame for the shambles and confusion. They have been more than adequately warned.

John Hutton: The purpose and effect of clause 40 are self-evident. I do not want to say much about it. It is a standard clause, setting out the Bill's short title and a range of other technical matters concerning commencement.
 I want to respond briefly to the hon. Gentleman's final, acerbic comments about the process of NHS reform. I understand, as do, I think, all my hon. Friends, that the hon. Gentleman and his party are opposed to the reforms that we are introducing, and to the scale and pace of them. That is well documented. His comments in that regard do not need to be added to the record any further. 
 It is untrue to describe the present process either as a shambles or as in any way dependent on the provisions of the Bill. I tried to explain to him earlier—it seems like a long time ago—that the PCTs that are being, or that have already been, established are not being set up under the terms and provisions of this Bill. How could they be?

Simon Burns: We understand that.

John Hutton: The hon. Gentleman says that he understands that, but he has repeated the argument that we are using the Bill to rush forward the establishment of PCTs. That is simply untrue. The power to establish them was contained in the Health Act 1999. All that this Bill does in relation to PCTs is to require the Secretary of State to maintain universal coverage of them. The process of establishing them has nothing whatever to do with the passage of this Bill.
 We do not want to be swapping prophecies and predictions of the future across the Committee—that would be pretty tedious. If either I or the hon. Gentleman should be proved wrong in future about the passage of these reforms, I have a strong feeling that it will not be me.

Simon Burns: May I just correct something? We fully understand that the powers to set up PCTs are not in the Bill. We have never said that; PCTs were established under the Health Act 1999. The Minister does not seem able to grasp that. Perhaps I am not making myself clear enough. Without going into great detail, the 1999 Act provided the statutory power for PCTs to be established on a voluntary basis.
 The Minister said that by October next year every area will have a PCT and a strategic health authority. That is a complete change from the current system, and 75 per cent. of the funding will go to the PCTs. That situation is a consequence of the Bill, even though it does not create it. Many PCTs are in a fragile state. That is not a criticism, because they are new bodies finding their feet and establishing themselves. Some of them have not yet even become PCTs, so they are even more fragile.
 We are simply saying that instead of ensuring that every area has a PCT by October next year and that they are getting the 75 per cent. funding and carrying out the functions envisaged under the Bill, the Government should leave it for another six months to give them a breathing space to bed themselves in and to gain more experience and expertise to be able to carry out those functions. 
 The Minister says that we are against all this, but he is a fair man, so he should admit that we are not opposed to the concept of PCTs and never have been. We did not fight the last general election on a policy of getting rid of PCTs. It is unfair for the Minister to draw the conclusion that we are against PCTs per se, and it would be gracious of him to recognise that. We simply think that they should have a little more time to bed in and establish themselves before taking on this massive transformation in their roles once they start receiving the money to provide local health care.

John Hutton: I do not want to maintain this argument, because it is running the risk of becoming rather repetitive. We have been over the tracks many times.
 I am prepared to accept the hon. Gentleman's assurances that Conservative Members support PCTs and their new role. He is right to say that he has made their position clear in the past. I recognise that what they object to is the pace at which we are moving towards PCTs assuming their responsibilities. Nevertheless, I think that he is wrong. If we believe in devolution to the front line by creating a devolved NHS that looks less like the monolithic top-down command-and-control organisation that it is, the sooner that we can do so the better. 
 However, I take to heart the hon. Gentleman's admonition that we must do it in a way that allows the PCTs to discharge their responsibilities effectively. Conservative Members have made reasonable criticisms in the course of our proceedings. We have been working hard to support PCTs in taking on their new responsibilities, and I am confident that as we move to 100 per cent. coverage under the voluntary 
 provisions in the Health Act 1999 they will be fully adequate in discharging their important responsibilities. 
 Question put and agreed to. 
 Clause 40 ordered to stand part of the Bill. 
 Question proposed, That the Chairman do report the Bill, as amended, to the House.

John Hutton: I welcome the progress that we have made, Miss Widdecombe, and express to you and Mr. Hurst my appreciation, and that of my hon. Friends, for the expert way in which you have both chaired the Committee's proceedings. I know that Ministers often say that at this point, but I mean it most sincerely. You have been firm, clear, decisive and, above all, fair to both sides of the Committee.
 I am also grateful to the Clerks and all those who have facilitated the prompt and efficient dispatch of this important Bill.

Simon Burns: On behalf of the Opposition, Miss Widdecombe, I join the Minister in thanking both you and Mr. Hurst for the way in which you have chaired our proceedings. This has been a hard-fought Committee on points of policy, and we, as a responsible Opposition, have sought to help and guide the Government and to encourage them to avoid some of the pitfalls that we believe that they are opening up for themselves. However, the proceedings have not been marred by rancour or unpleasantness. Of course, it would have been marvellous to have heard more contributions from Labour Members. I was awaiting with interest the speech by the hon. Member for Crawley on the manuscript amendments, owing to her great concern about the issue. Overall, it has been a pleasure to serve on the Committee.

Ann Widdecombe: I thank both hon. Gentlemen for those comments, and add my thanks to the police, Hansard, the Clerks and, indeed, members of the Committee, who made it easy for me to learn about the role of Chairman and ease myself into it. I am sure that as a result of this Committee's model conduct I shall now be unleashed on something much worse.
 Question put and agreed to. 
 Bill, as amended, to be reported. 
Committee rose at seven minutes past Three o'clock.